With the start of a new semester, parents of college students, especially those taking Adderall, should be on the alert. Legally prescribed amphetamine in the form of Adderall has become ubiquitous on college campuses and in the more affluent high schools of our country. The drug is ostensibly being used to treat adult attention-deficit/hyperactivity disorder (ADHD) or as it’s more generally known as attention deficit disorder (ADD). Perhaps even more common is the illegal selling or trading of Adderall to students who have not been designated with ADD, especially at the end of a semester or during exam time.

The existence of ADD in adults is beyond dispute in our country. However, amphetamine (and its close pharmacological sister, methylphenidate – Ritalin or Concerta) affects everyone the same: increasing alertness, energy, and the ability to stick with tasks that are boring or difficult. While it may improve performance leading to higher grades it does not increase intelligence or higher cognitive functions. Still, Adderall has become awfully popular among students.

But the drug has a downside that’s been known since the 1930s: there’s a risk of misuse, abuse and addiction that’s virtually identical to methamphetamine (meth) abuse and addiction.

At college, adult ADD can be the problem but is easily confused or intermingled with learning weaknesses, inconsistent motivation and the partying life especially associated with Greek (fraternities and sororities) university environments. Attempts to tease out ADD from other problems require hours of testing and may still come down to a subjective decision for the evaluator and subject. Malingering (faking ADD symptoms in order to obtain the drug or accommodations like extra time for taking tests) is relatively easy to do and has become another challenge for universities.

Despite these concerns, doctors continue to prescribe Adderall, because on the short-term it “helps.” Adderall comes in an immediate release form (IR) which begins working in twenty minutes and lasts about three to four hours and in a long acting extended release form called Adderall XR, which takes a bit longer to kick in and may last as long as ten hours.

It should come as no surprise that many, if not most, college students left on their own would prefer the short acting variety of Adderall which provides the most flexibility in terms of use. Adderall XR, while lasting longer requires more planning and scheduling – especially because difficulty falling asleep is one of the side effects of amphetamine. If one takes Adderall XR much after noon the student is likely to have problems falling asleep for much of that night.

But there’s a hidden sinister side to IR Adderall. Allowing the student to pick and choose their time of use facilitates a tendency for the student, especially with the ADD habits of procrastination and disorganization, to not use the medication on a regular basis. Then he/she takes it excessively towards the end of the semester when work and the need for studying for exams have piled up. At that time of year, excessive IR Adderall works to pull “all-nighters.”

This use of IR Adderall is not only the perfect setup for developing abuse and addiction patterns (even for those legally prescribed the drug), but also supports an ADD lifestyle which is the very reason the student is taking the drug. Furthermore, as-necessary-only dosing reinforces a psychological dependency on the drug that would not be associated with the use of Adderall XR.

Using Adderall XR (or Concerta, the long-acting version of methylphenidate) requires planning on the part of the student and prescribing doctor. In my practice, I ask students to predict, based upon their class and studying schedule, whether they plan to use the drug four to seven days a week (with less than four days I wonder if they really need the medication). Then we count out the pills and predict the day when they will run out of the medication. They have to be in touch with me either a week before or after in order to receive another prescription. If they call me only at the end of the semester I will not prescribe the drug to them. Even though they could easily get the medication from friends or dealers, at least I (Primum non nocere!) would not be cooperating with the continuation of the misuse of this drug for this student.

There’s a broader reason why doctors should not be prescribing IR Adderall to college students. IR Adderall is the easiest preparation to crush and snort for getting high – and is absolutely the preferred preparation for Adderall abusers and addicts. Concerta, when crushed, turns into a paste and cannot be snorted. Even Adderall XR’s tiny balls require a mortar and pestle. Vyvanse, another long acting amphetamine preparation that was designed to be inactive unless swallowed, is probably the best choice for older teens and college students. But IR Adderall without a doubt is the riskiest.

Parents need to know what their ADD college student is taking and how. Poor judgment is yet another feature of adolescence and especially pronounced in ADD kids. If privacy/confidentiality is a concern, then the parents would have to get permission from their over 18-year old. But the same is true for parents keeping an eye on their children’s grades in college.

Unfortunately, parents will have to be the vigilant ones here. Primary care doctors and even psychiatrists, too often take the easy way out in terms of diagnosis and treatment, giving the college student what he or she wants. Even experts who have been very pro-ADD/drug, like Timothy Wilens, of Harvard’s Pediatric Psychopharmacology Clinic, have publicly stated that doctors should not be prescribing IR Adderall to their college student patients. And yet the doctors continue to do so. Therefore, it will be up to the students themselves and their caring parents, to choose carefully and wisely, when taking drugs like Adderall.